Medicaid Update: Coverage of Medically Necessary Donor Human Breast Milk

Effective July 1, 2022, for claims with dates of service beginning July 1, 2022 and after, Donor Human Breast Milk is covered for Medicaid and CHIP members, ages 0-6 months, in the inpatient hospital setting.  Providers must bill for Donor Human Breast Milk utilizing CPT code T2101.  The reimbursement rate is $4.89 per ounce/unit.  The maximum number of allowable ounces/units is 15 ounces/units per day. The maximum allowable units per member, per lifetime is 1,260 units.

Should you have additional questions or concerns, please contact the Gainwell Technologies Call Center at 770-325-9600 or 1-800-766-4456 or contact us at